Surgical treatment of constipation is reserved for cases of refractory constipation, with delayed intestinal transit.Ĭonstipation is a common symptom that may be primary (idiopathic or functional) or associated with a number of disorders or medications. In case of failure, the use of lubiprostone is indicated, as well as linaclotide. Therapy begins with lifestyle modification, and in case of failure, bulk or osmotic laxatives are used. Key Messages: Two key things when taking a medical history and physical examination are to rule out the existence of alarm symptoms/signs and to rule out secondary constipation (primarily drug-induced). Nonoperative therapy includes the application of a lifestyle measures, pharmacotherapy and biofeedback therapy. Constipation therapy can be both nonoperative and operative.
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This includes the use of laboratory, endoscopic, and radiological examinations, as well as advanced physiological testing (anorectal manometry, balloon expulsion test, colonic transit studies, and defecography). In selected cases, the use of additional diagnostic procedures is very important. The diagnostic and therapeutic approach to patients with constipation begins with a detailed history and physical examination. Constipation can be primary or secondary. The prevalence of constipation is about 16%. Thus far, lubiprostone offers a novel approach to our therapeutic armamentarium, however, there is a need for more drugs with different mechanisms of action, in order to treat constipation that is often multifunctional.Ĭonstipation is a common problem in gastroenterological practice. Based on current product labeling, it is recommended that 8 μg bid be started in patients with IBS-C whereas 24 μg bid be used in those with chronic constipation.
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Given the overlap between chronic constipation and IBS-C, clinicians can consider two strategies when deciding on the initial dose of lubiprostone.
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Based on the available evidence, it is reasonable to conclude that lubiprostone should be added to the short list of evidence-based pharmacotherapies for chronic constipation and IBS-C.
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It has little systemic absorption and almost free of any serious adverse effects, however, occasionally can cause nausea. Several trials have shown it to be effective in the treatment of chronic idiopathic constipation, and recently also IBS-C. It is an oral bicyclic fatty acid that selectively activates type 2 chloride channels in the apical membrane of the intestinal epithelial cells, hence stimulating chloride secretion, along with passive secretion of sodium and water, inducing peristalsis and laxation, without stimulating gastrointestinal smooth muscle. Lubiprostone (Amitiza) has been approved by the US Food and Drug Administration (FDA) for the treatment of chronic-idiopathic constipation. Over time, most patients become refractory to one or more laxatives.
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The treatment of these disorders is often empiric and most current therapies are indicated for episodic constipation. Chronic constipation and IBS-C are two of the most common functional bowel disorders encountered by primary care providers and gastroenterologists, affecting up to 27% of the population in Western countries.